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Shoulder: SLAP Lesion and Cortisone

I have a SLAP lesion [a cartilage tear on the rim of the shoulder socket] having injured my shoulder seven months ago. My D.O. gave me a cortisone shot yesterday and I actually feel worse. I have started P.T. I don’t want to have surgery, but not climbing is bringing me down. All of my therapy is geared to the supraspinatus.

—Matt Kandrick | RI Forum

I like the cut of your jib, sailor; that’s a fine plan.

I’m not sure why the P.T. is concentrating on your supraspinatus muscle, given that you have not mentioned a tear in it (which would have shown up in the MRI). Certainly, exercises that target the four muscles that constitute the rotator cuff (supraspinatus being but one) and shoulder control in general are worthy.

If the supraspinatus is in pain, then it is surely secondary to another issue. Concentrating on it is like cleaning your windshield while driving through a mudslide. Given the reverence with which the supraspinatus is treated in modern rehab, anyone would think it were the global CEO of shoulder motor control, when in fact it’s just middle management.

There are four basic types (and some sub-genres) of SLAP lesions. Most are simply fraying of the cartilage edge (Type 1) and the vast majority will settle. Still, it is difficult to know what the correlations are between the extent of damage and the need for surgery, since even MRIs are unable to reliably reveal the extent of damage to the glenoid labrum. The upshot is that we don’t really know how many of the more serious tears actually settle without surgery.

The best indicators for surgery are ongoing pain and/or a sense of locking in the joint. Pain that takes several months to settle is quite normal. Seven months is a long time and if it has not settled in the next few I would certainly consider surgery.

Strengthening the shoulder now will double as “prehab” if you end up needing an operation, so your time is far from wasted. If you have any sense of locking in the joint, like something is getting stuck and you have to reverse the movement to free it up, talk to your surgeon. The damage is likely to be extensive and surgery is really your best option.